Providers sign on for another Iowa Medicaid transition

Iowa Total Care to join Monday; some hospitals finalized contracts this week

#x201c;We have processes in place and plans in place to ensure as smooth a transition as possible, with no disruption to
“We have processes in place and plans in place to ensure as smooth a transition as possible, with no disruption to member services,” Iowa Medicaid Enterprise Director Michael Randol says. (Rebecca F. Miller/The Gazette)

Several Eastern Iowa health care providers have signed on with the new insurance company entering Iowa’s Medicaid program — a decision some officials say was driven out of necessity to serve their patients and overruled their concerns for the privatized program.

On Monday, Iowa Total Care will be the latest managed-care organization to join Iowa’s $5 billion Medicaid program that administers health coverage for more than 625,000 poor and disabled Iowans.

As this is not the first transition from one managed-care organization to another since Iowa Medicaid moved to managed care three years ago, some health care officials expressed concern for the long-term stability of the program.


UnitedHealthcare is scheduled to exit Iowa's Medicaid program Sunday. Iowa Total Care is set to enter the program on Monday. Here's what you need to know about the upcoming transition to the state's managed care system.

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Iowa Total Care’s entrance into the market will come a day after another managed care organization will exit. UnitedHealthcare — withdrawing on Sunday — criticized the state for chronic underfunding the program, which caused the insurer to lose millions of dollars.

State officials, on the other hand, said they ended contract negotiations in March due to “unreasonable and unsustainable” demands from UnitedHealthcare.

With that departure, Medicaid members are to be split evenly between the two remaining insurers, Amerigroup and Iowa Total Care, the state said.

AmeriHealth Caritas left the state’s privatized program in 2017.


But despite concerns on the upcoming transition, opting to not sign on with Iowa Total Care was never a consideration for Tracy Gray, director of home health agency Always Best Care: Senior Care in Cedar Rapids.

“We’ll continue to sign on with any managed-care organization that comes across because we want to give our clients the option,” Gray said.


In the weeks leading up to July 1, state officials often have emphasized no member will lose his or her coverage in the transition to the new insurer.

On Friday, Gov. Kim Reynolds said she believes the changeover will be seamless.

“I’m really proud of the team and with Iowa Total Care, they’ve worked really hard to make sure they have network adequacy and they’ve had all the major hospitals sign on,” she said. “I’m sure there will be a few bumps, but I feel very confident in where we’re at to really try to minimize the disruptions as much as we can.”

Iowa Medicaid Enterprise Director Michael Randol also is confident it will be a good transition.

“Will there be some bumps in the road? Absolutely,” Randol told The Gazette. “I’m not naive to think it’s going to be perfect. Nothing’s going to be perfect with respect to a transition, whether it’s Medicaid or commercial or anything else.

“We have processes in place and plans in place to ensure as smooth a transition as possible, with no disruption to member services,” he said.

Officials have been working to sign contracts with various health care providers and, on June 17, Iowa Total Care said it had signed contracts with four of the state’s largest systems — UnityPoint Health, University of Iowa Health Care, MercyOne and Genesis Health System.

“I’m very pleased with where they are as far as prospective network adequacy and I don’t anticipate any issues come July 1,” Randol said.

Mitch Wasden, Iowa Total Care president and chief executive officer, said in an emailed statement Friday afternoon that his company was ready.


“We have been testing our systems for months to ensure the smoothest possible transition for members and providers,” Wasden said. “We staffed up — more than 95 percent hired by June. We take a local, boots-on-the-ground approach, with 820 people working right here in Iowa.”

He added that, “We know Medicaid: Our local teams are backed by comprehensive, national data and expertise.”

Wasden said patients covered through Medicaid are “just as satisfied ... as people with insurance through their employer — close to 75 per-cent. And people who had their coverage through a managed-care company, like Iowa Total Care, had higher satisfaction — 86 percent — than people covered through the fee-for-service model.”

Randol said some smaller providers still were in negotiations last week, including a number of area hospitals.

Virginia Gay Hospital, a 25-bed facility in Vinton, was finalizing its contract this week, Chief Executive Officer Michele Schoonover said.

“We almost felt like we had to sign up because there’s only two” managed-care organizations, Schoonover said. “That’s just money you kind of leave on the table if you don’t sign up.

“It’s better to be getting a small percentage than less than that percentage. And we want to be available to our patients.”

The concern about unpaid reimbursement is something that lingers in the back of some health care providers’ minds, and it’s an issue some have criticized Iowa’s providers have criticized state officials for not addressing.


Virginia Gay Hospital filed a lawsuit against the managed-care organizations this past year for more than $91,000 in unpaid reimbursements between 2016 and 2017. Schoonover said the hospital recently turned down a settlement offered to it by the companies.

Steve Slessor, chief executive officer of Buchanan County Health Center in Independence, said managed care has cost hospitals more than the former state-run Medicaid program.

But Buchanan County still signed a contract with Iowa Total Care last week because, ultimately, “you’re putting patients in the middle of this,” Slessor said.

“It’s a difficult situation when only provider in town has chosen not to be in their network,” he said.


Gray, of Always Best Care: Senior Care, estimated about 80 percent of its 150 patients use Medicaid for their non-medical home health care needs, which includes personal care, transportation and respite care.

Gray said her business, as well as her clients, had a difficult time in the switch to managed care in 2016. The exit of AmeriHealth in 2017, and the subsequent shift for members to UnitedHealthcare, also was a hurdle with which Gray had to help her clients grapple.

With each transition, Gray said, some of her clients — who rely on caregivers for their meals and trips to the doctor’s office each week — were “thrown into a panic.”

And now, with the transition this weekend with UnitedHealthcare’s exit and Iowa Total Care’s debut, Gray said she is preparing herself and her clients to deal with the same questions and the same worries.

“When you’re changing something as big as an insurance company, to them, that’s life-changing,” Gray said. “That’s not something you want to do when you already have anxiety and you already know what you’ve gone through before.”


But Randol of Iowa Medicaid Enterprises said there are differences between the transitions following AmeriHealth and UnitedHealthcare departures, including the notice each company presented to the state before exiting — AmeriHealth gave 30 days and UnitedHealthcare gave 90 days.

He also noted that when AmeriHealth departed from the program, it left the state’s insurance market completely.

“They have no presence in the state of Iowa,” Randol said. “UnitedHealthcare is leaving the Medicaid market, but they still have a strong commercial and Medicare presence in the state of Iowa, so they want to maintain those relationships on a positive manner with those providers and advocates and members.”

A timeline of Medicaid managed care in Iowa

January 2015 — Gov. Terry Branstad announces a plan to shift Iowa’s state-run Medicaid system to a managed-care program.

August 2015 — Iowa accepts the bids of four insurance companies vying to be managed-care organizations within the state’s Medicaid program. One insurer eventually is dropped from the program, and three would go on to administer health care for members — AmeriHealth Caritas Iowa, Amerigroup Iowa and UnitedHealthcare Plan of the River Valley.

December 2015 — The federal Centers for Medicare and Medicaid Services — the agency that must approve the managed-care implementation — cites concerns of an inadequate provider network. Officials tell Iowa that it must wait until March 1 to transition to a managed-care program.

February 2016 — Federal officials approve Branstad’s Medicaid plan. The implementation date is set for April 1, 2016.

April 1, 2016 — Iowa moves to a managed-care program and the majority of members are moved under the managed-care organizations.

October 2017 — AmeriHealth Caritas, one of the managed-care organizations in Iowa’s Medicaid program, announces it will withdraw from the state. AmeriHealth members are to be moved to the remaining two insurers.


November 2017 — Amerigroup Iowa, one of the two remaining managed-care organizations, says it does not have capacity to take any new members from AmeriHealth.

December 2017 — AmeriHealth exits Iowa’s Medicaid program and the majority of its members are moved to UnitedHealthcare.

December 2017 — Mike Randol begins his tenure as Iowa Medicaid Enterprises director. He leaves Kansas, where he held a similar position, as that state seeks insurers to manage a new version of its program for 2018.

May 2018 — Following a request-for-proposal process, Iowa Total Care — owned by St. Louis-based Centene — is selected to join Iowa’s program as a managed-care organization.

March 29, 2019 — UnitedHealthcare announces it will withdraw from the state’s now $5 billion Medicaid program. The 425,000 members under UnitedHealthcare will be moved to Amerigroup or Iowa Total Care, officials say.

June 30 — UnitedHealthcare will leave Iowa’s Medicaid managed-care program.

July 1 — Iowa Total Care officially to join the Medicaid program.

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